Not in Kansas any more: Alan Crockard’s resignation letter decrypted.

Professor Alan Crockard is a neurosurgeon. He was until yesterday also the National Director of Modernising Medical Careers, which may be the crack that’s needed to split open MMC and get some fresh air and new thinkers.

Here is the text of his letter to the Chief Medical Officer, Sir Liam Donaldson, with my emphases and commentary. When I first read it, I thought he sounded like a sincere man, perhaps a bit older and wiser and sadder than before. Like a neurosurgeon who had tried medical education and politics, and found them harder than he expected.

But then I read it again…

Dear Liam

I wish to resign from my position as National Director for Modernising Medical Careers with immediate effect. I am increasingly aware that I have responsibility but less and less authority.

I know I’m going to be blamed for all this, so I am going to go before I am pushed, but it wasn’t my-y-y-y-y fault.

I care deeply about medical education and training. In 2003 I moved from the College of Surgeons where I was Director of Education to join the MMC team. At the College we developed a competency based curriculum. These ideas rolled over into MMC where the team put together the Foundation Programme which was launched in 2005. It also involved coordination of the stakeholders in curriculum development, training the trainers and carrying out numerous road shows to set the scene for consultants and trainees. It is now considered successful and fit for purpose. In addition the doctors completing the Foundation Programme this year seem as if they will match well into the new Specialty Training Programmes.

See! Look! We got the F1/F2 stuff right.

As a prelude to new Specialty Training, MMC worked closely with PMETB and all the stakeholders to facilitate the new competency based curricula and set the scene for such a radical change in training.

Manifestly, specialty training is an order of magnitude more complex than Foundation,…

Um. The next bit was really hard.

…but it became obvious that the MMC team’s expertise was less used in planning of specialty rollout.

And they didn’t ask our advice – so it’s not our fault they got it wrong.

How can the National Director of the MMC say that the MMC weren’t asked to design and implement the MMC? – AB

MTAS was developed and procured by DH outside my influence.

Not my fault, guv. I wasn’t even there

An email (12 October 2005) to our team made it abundantly clear that Debbie Mellor has been tasked with delivering a recruitment system to recruit junior doctor posts specifically FP1s and ST1s.

Look! Look! It’s her!

I am not clear how far you should (or want) to be involved in this. We don’t want to tread on any toes, but equally we need to be clear about what level of autonomy this Programme has.

The MMC programme has been the subject of an OGC Gateway Review in September 2006 (DH331), they concluded “that the programme has made significant progress since the OGC health check in August 2005″.

“has made significant progress” is not the same as “has been successfully delivered”. A cervix that won’t dilate past 3cm could be said to have made signficant progress. Of course, he’s a neuro-surgeon not an obstetrician.

The report overall was supportive of MMC, but there was one serious red risk. This was to identify a clear break point for the MTAS project beyond which the contingency arrangements should be activated.

I don’t actually understand this, and I am good at understanding management-consultant-speak.

I think he’s saying that the MTAS people had failed to create a “Plan B”, though he may be saying that they had failed to work out in advance when they should say “Plan A isn’t working, we must implement Plan B”.

It’s impossible to tell if he is referring to the technology here (extra server capacity, extra bandwidth stuff like that) or if he is referring to the people side of the process – making sure there were enough people to mark the applications, and so on.

Peerhaps the fullstop is in the wrong place. He might mean “The report overall was supportive of MMC. However there was one serious red risk: this was to….”

It also commented on the unclear leadership between DCMO and two senior responsible officers. From my point of view, this project has lacked clear leadership from the top for a very long time.

And now he’s got the nerve to say I told you so.

Moving to the last few weeks, I have become increasingly concerned that the well intentioned attempts to keep the recruitment and selection process running have been accompanied by mixed messages to the most important people in the whole process the young doctor applicants. I realise that the service must continue to allow patients to be treated and I know little of the law, but it seems to me basically unfair to advertise the possibility of four interviews and then suggest that these might not be honoured. Equally devastating would be the suggestion of some stakeholders, that the completed interviews be discarded and the process be rerun. I accept that in many areas and in many specialties, this round of recruitment and selection has been acceptable. But the overriding message coming ack from the profession is that it has lost confidence in the current recruitment system.

I’m not even going to comment on this last paragraph, it consists entirely of flannel dipped in oil.

With my very best wishes.

Alan

Nothing at all about cutting the numbers of Specialst Training posts.

An impressive bodyswerve past the fact that there are significant question-marks about the likely effectiveness of the Specialist Training.

A complete blank on his responsibility as National Director of MMC for the changes introduced by MMC. He associates himself only with the bits that have gone well.

No hint at all that the transition from old to new has been forced through.

I did a Google search for “Debbie Mellor” (ref. Alan Crockard’s letter of resignation) and came across this link to a House of Commons oral evidence transcript on “Workforce Planning” dated 11 May 2006. It is long but is worth reading in full since it covers a lot of different aspects and also shows how civil servants get grilled from time to time.

Contrary to current opinion, Liam Donaldson seems fairly adamant that there will be a need for more doctors not less, and one of the reasons he gives is 70% feminisation of the medical workforce. (Questions 107, 115, 117 and 118)

It appears that the concept that we are overproducing doctors is simplistic, and being generated by the Royal Colleges in order to be provocative, amuse, and keep parliament on its toes!